“One of the Department’s most important tools in protecting the integrity of Medicare and other taxpayer-funded health care programs is the civil False Claims Act” – Deputy Attorney General, June 3, 1998
“Qui tam,” is an abbreviated form of the Latin legal phrase ‘qui tam pro domino rege quam pro se ipso in hac parte sequitur’ which means “he who brings a case on behalf of our lord the King, as well as for himself.” Thus, it is an ancient cause of action rooted in the medieval belief that the subjects of a King should look out for the interests of their King and Country. By doing this, the subject can save the Kingdom from loss and the King in turn felt fit to reward the subject for such loyal action.
The modern day American Qui Tam action permits regular folks to bring an action on behalf of the Government when they learn that someone or some company has defrauded the Government. Most qui tam actions are filed under Federal False Claims Act, 31 U.S.C. §§ 3729-3733. Similarly, many states, including Colorado, have their own False Claims Act laws that serve the same function where the state or even local governments have been defrauded. And, just like in medieval times, the person who initiates the action and “saves” the Government will be rewarded – with a percentage of the Government’s recovery.
Qui Tam actions are initiated by a “whistleblower” who is literally blowing the proverbial whistle on a company who is defrauding the Government. The technical term for this person is called the “Relator.” The Relator will file a lawsuit “under seal”, which means only the person who files it and the Government know about it. This is done in secrecy to allow the Government to investigate the allegations and decide if they want to “intervene,” meaning they will take over the prosecution of the case. This is generally done by the United States Attorney’s Office.
The Government has sixty days to make this decision but this time period is often extended if necessary for the Government to conduct its investigation. At the end of this time period, the Government will make a decision on whether or not to intervene. If the Government does decide to actively intervene, the Relator becomes a spectator while the Government takes over the case and prosecutes the cheating company or individual. If the Government succeeds in the case and recovers money, the Relator is rewarded by receiving anywhere between 15-30% of the recovery. If the Government decides not to intervene, the Relator must decide whether to proceed with the lawsuit on their own. If the government intervenes or the case otherwise proceeds, the lawsuit will be unsealed and the defendant notified. This is generally the first time a defendant becomes aware that a False Claims Act case has been filed.
There are certain protections for the whistleblower afforded by the False Claims Act. First, the Defendant is kept in the dark until the Government makes it decision. Second, if the whistleblower is an employee of the company he reports on, he cannot be fired or disciplined because he blew the whistle. These protections are in place, along with the 15-30% share of the result, to encourage folks to alert the Government when it is being cheated without fear of reprisal from their employer.
As is often the case in life, timing is everything. In order to qualify as a legitimate whistleblower, you need to be the first to report the fraud and the information cannot already be known to the public. Thus, it can often be a race to the courthouse to report fraudulent activity. There are also applicable statutes of limitations for these actions – the Federal False Claims Act only allows six years to report fraud.
The False Claims Act is a powerful government tool for weeding out fraud and protecting taxpayer money. Since 1986, the federal government has recovered more than $30 billion in settlements and judgments through lawsuits brought under the False Claims Act, $14.2 billion since 2009. In 2011 alone, the Justice Department recovered more than $3 billion. In 2012, that figured jumped to $5 billion.Part of a reason the False Claims Act is so effective is because it allows for recovery of treble damages, as well as costs, attorneys’ fees and various monetary penalties.
False claims can relate to Medicare, Medicaid, and other healthcare fraud, military and other government contracts, failure to pay government fees, royalties or other money due to the government (referred to as “reverse false claims”), federal grants, billing for needless medical services (e.g. “upcoding”), and improper promotion of off-label use of pharmaceutical drugs.
The term “claim” is defined very broadly under the False Claims Act. Under the Act, a claim means any request or demand for money or property that:(i) is presented to an officer, employee, or agent of the United States; or(ii) is made to a contractor, grantee, or other recipient, if the money or property is to be spent or used on the Government’s behalf or to advance a Government program or interest, and if the United States Government:
Therefore, claims submitted to state, local or private programs can also fall under the federal False Claims Act if those programs are funded in part by the federal government. An example would be a state Medicaid program.
If you believe you have information which might allow you to file an action under the False Claims Act, contact Zaner Harden Law for a free and confidential consultation by calling (303) 563-5354. Or, you can compete our Free Case Evaluation Form and we will contact you.
Contact Zaner Harden Law for a free and confidential consultation by calling (303) 563-5354. Or, you can complete our Free Case Evaluation Form online and we will contact you.